ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
Tax period: 2010-10-01 to 2011-09-30
Filed: 2012-05-10
IRS object ID: 201211319349301926
Schema version: 2010v3.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-10T13:02:03-05:00	Timestamp
Tax Period End Date	2011-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BAKER NEWMAN & NOYES	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	650 ELM ST SUITE 302	AddressLine1
City	MANCHESTER	City
State	NH	State
ZIP Code	03101	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	020222791	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	ALIC	NameControl
Phone	6034483121	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	125 MASCOMA STREET	AddressLine1
City	LEBANON	City
State	NH	State
ZIP Code	037662647	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	EVALIE M CROSBY	Name
Title	VP FINANCE & CFO	Title
Phone	6034483121	Phone
Date Signed	2012-05-08	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Elizabeth Loudermilk	Name
Phone	8002447444	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	HARRY G DORMAN III	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	125 MASCOMA STREET	AddressLine1
City	LEBANON	City
State	NH	State
ZIP Code	037662647	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	52744048	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.ALICEPECKDAY.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1943	YearFormation
State Legal Domicile	NH	StateLegalDomicile
Activity Or Mission Description	CRITICAL ACCESS HOSPITAL	ActivityOrMissionDescription
Nbr Voting Members Governing Body	21	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	18	NbrIndependentVotingMembers
Total Nbr Employees	494	TotalNbrEmployees
Total Nbr Volunteers	106	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	1029971	ContributionsGrantsPriorYear
Contributions Grants Current Year	462323	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	42411307	ProgramServiceRevenuePriorYear
Program Service Revenue CY	50223338	ProgramServiceRevenueCY
Investment Income Prior Year	137115	InvestmentIncomePriorYear
Investment Income Current Year	106115	InvestmentIncomeCurrentYear
Other Revenue Prior Year	48297	OtherRevenuePriorYear
Other Revenue Current Year	40165	OtherRevenueCurrentYear
Total Revenue Prior Year	43626690	TotalRevenuePriorYear
Total Revenue Current Year	50831941	TotalRevenueCurrentYear
Grants And Similar Amnts CY	41450	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	23580477	SalariesEtcPriorYear
Salaries Etc Current Year	28733724	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	86744	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	370053	TotalFundrsngExpCurrentYear
Other Expense Prior Year	17285987	OtherExpensePriorYear
Other Expenses Current Year	20456710	OtherExpensesCurrentYear
Total Expenses Prior Year	40866464	TotalExpensesPriorYear
Total Expenses Current Year	49318628	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	2760226	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1513313	RevenuesLessExpensesCY
Total Assets BOY	28392505	TotalAssetsBOY
Total Assets EOY	33647872	TotalAssetsEOY
Total Liabilities BOY	15278155	TotalLiabilitiesBOY
Total Liabilities EOY	19624880	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	13114350	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	14022992	NetAssetsOrFundBalancesEOY
Mission Description	THE MISSION OF ALICE PECK DAY MEMORIAL HOSPITAL IS TO PROVIDE PATIENT-FOCUSED HEALTH CARE SERVICES THAT ARE RESPONSIVE TO COMMUNITY NEEDS, TO PROMOTE WELLNESS, AND TO CONTINUALLY IMPROVE THE QUALITY OF HEALTHCARE SERVICES IN THE COMMUNITY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	45652832	Expense
Grants	41450	Grants
Revenue	50127040	Revenue
Description	ALICE PECK DAY MEMORIAL HOSPITAL IS A COMMUNITY-BASED HOSPITAL OPERATING IN LEBANON NH. THE HOSPITAL BEGAN AS A SMALL COTTAGE HOSPITAL IN 1932. FROM ITS HUMBLE BEGINNINGS, ALICE PECK DAY HAS CONTINUALLY DEMONSTRATED ITS COMMITMENT TO PROVIDE PATIENT-FOCUSED HEALTH CARE SERVICES WHICH IMPROVE THE QUALITY OF LIFE WITHIN ITS COMMUNITY AND PROMOTE WELLNESS FOR ALL. ALICE PECK DAY MEMORIAL HOSPITAL IS A CHARITABLE HEALTH CARE ORGANIZATION WHICH IS DEDICATED TO SERVING ITS COMMUNITY. THIS COMMITMENT INCLUDES GRANTING CREDIT TO PATIENTS, SUBSTANTIALLY ALL OF WHOM ARE LOCAL RESIDENTS. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ESTABLISHED RATES. COLLECTIONS ARE NOT PURSUED FOR AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY, THE ESTABLISHED COSTS OF THE SERVICES AND SUPPLIES AND EQUIVALENT SERVICE STATISTICS. FOR THE YEAR ENDED SEPTEMBER 30, 2011: CHARGES FORGONE BASED ON ESTABLISHED RATES WERE $942,000 WITH CHARITY CARE AT COST OF $629,000. ESTIMATED COSTS INCURRED IN EXCESS OF PAYMENT FOR INPATIENT AND OUTPATIENT SERVICES FOR MEDICAID PATIENTS IN THE YEAR ENDED SEPTEMBER 30, 2011 WERE $1,994,000. IN ADDITION TO THE CHARITY CARE SERVICES DESCRIBED ABOVE, THE HOSPITAL PROVIDED A NUMBER OF OTHER SERVICES FOR WHICH LITTLE OR NO PAYMENT WAS RECEIVED. SERVICES INCLUDED COMMUNITY HEALTH SERVICES, HEALTH PROFESSIONAL EDUCATION, COMMUNITY BUILDING ACTIVITIES, AND COMMUNITY BENEFIT PROGRAMS. SERVICES RANGED FROM COMMUNITY FLU CLINICS, UPPER VALLEY SMILES DENTAL PROGRAM, STUDENT AND PROFESSIONAL EDUCATION, EMERGENCY PHARMACY VOUCHERS AND INCLUDED MANY OTHER PROGRAMS WHICH CONTRIBUTED TO AND SUPPORTED OUR COMMUNITY. AS A LOCAL HOSPITAL, ALICE PECK DAY WORKS CLOSELY WITH COMMUNITY ORGANIZATIONS TO ADDRESS COMMUNITY NEEDS. ORGANIZATIONS THAT WERE BENEFICIARIES OF THE HOSPITAL'S STAFF, TIME, AND/OR MATERIALS INCLUDE: ALCOHOLICS ANONYMOUS, AARP, AMERICAN LEGION, AMERICAN RED CROSS, AWAKE SUPPORT GROUP, BONNIE CLAC, BROOKSIDE NURSING HOME, CHILDBIRTH EDUCATION AND POSTPARTUM MASSAGE, COMMUNITY HEALTH DEPARTMENT, DARTMOUTH MEDICAL SCHOOL, ELMIRA COLLEGE, GOOD BEGINNINGS OF SULLIVAN COUNTY, GOOD NEIGHBOR HEALTH CLINIC, GRAFTON COUNTY SENIOR CENTER, GRAFTON COUNTY SENIOR CITIZENS COUNCIL, LEBANON AREA CHAMBER OF COMMERCE, LEBANON COLLEGE, LEBANON HOUSING AUTHORITY, LEBANON SCHOOL BIKE RODEO, LEBANON SCHOOL DISTRICT NATURE PROGRAM, OVER-EATERS ANONYMOUS, RIVER VALLEY COMMUNITY COLLEGE, ROGERS HOUSE, SAVVY SENIORS EXERCISE PROGRAM, STORRS HILL, UNITED VALLEY INTERFAITH PROJECT, UPPER VALLEY SMILES DENTAL PROGRAM, VERMONT INSTITUTE OF NATURAL SCIENCES, AND WEST CENTRAL BEHAVORIAL HEALTH. IN CERTAIN INSTANCES, ASSISTANCE WAS PROVIDED TO THE COMMUNITY FOR WHICH NO VALUE CAN BE PLACED. THIS ASSISTANCE INCLUDED LEADERSHIP IN IDENTIFYING COMMUNITY NEEDS, STAFF COMMITMENT TO VOLUNTEER FOR COMMUNITY ORGANIZATIONS, ADVOCACY AND SUPPORT FOR THE SOCIALY AND PHYSICALY DISADVANTAGED, AND SUPPORT FOR LOCAL PUBLIC SAFETY ORGANIZATIONS. ALICE PECK DAY CONSIDERS CARING FOR OUR COMMUNITY A SPECIAL RESPONSIBILITY THAT WE ARE HONORED TO FULFILL. THROUGH ITS MANY PROGRAMS, DEDICATED STAFF AND UNWAVERING COMMITMENT TO QUALITY CARE, ALICE PECK DAY WORKS TO EXCEED THESE EXPECTATIONS AND MAKE A REAL DIFFERENCE IN OUR COMMUNITY.	Description
Total Program Service Expense	45652832	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	true	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Info In Schedule O Part V	X	InfoInScheduleOPartV
Number Forms Transmitted With1096	61	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	494	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	21	NbrVotingGoverningBodyMembers
Number Independent Voting Members	18	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	NH	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	ELIZABETH LOUDERMILK	NamePerson
Telephone Number	6034483121	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	125 MASCOMA STREET	AddressLine1
City	LEBANON	City
State	NH	State
ZIP Code	037662647	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Reportable Comp From OrganizationReportableCompFromOrganization	Highest Compensated EmployeeHighestCompensatedEmployee
MICHAEL R HARRIS
CHAIR	1.0	X	X
REV DR GUY JD COLLINS
VICE CHAIR	1.0	X	X
JUDSON T PIERSON
TREASURER	2.0	X	X
KAREN G KAYEN
SECRETARY	1.0	X	X
BARBARA A CALLAHAN CRNA
MEDICAL STAFF PRESIDENT	1.0	X	X
MICHAEL J CRYANS
TRUSTEE	0.5	X
HARRY G DORMAN III
PRESIDENT AND CEO	60.0	X	X	308651	28361
TERRI C DUDLEY
TRUSTEE EMERITUS (NON VOTING)	1.0	X
CLAUDIA C GIBSON
AUXILIARY PRESIDENT	0.5	X
RICHARD S JENNINGS
TRUSTEE	1.0	X
BRUCE N JOHNSTONE
TRUSTEE	1.0	X
JENNIFER H JUDKINS
TRUSTEE	1.0	X
EDWARD T KERRIGAN
TRUSTEE	1.0	X
SARA L KOBYLENSKI
TRUSTEE	1.0	X
MIRIAM M MAGUIRE
TRUSTEE	0.5	X
SUSAN E MOONEY MD
VP & MEDICAL DIRECTOR	60.0	X	X		34892	242743
MICHAEL PWH PAINE FRCS
TRUSTEE	2.0	X
PAUL R BOUCHER
CHAIR- APD LIFECARE	1.0	X
MARTY P CANDON
TRUSTEE	1.0	X
MARK E MELENDY
TRUSTEE	1.0	X
SHELLY L MOSES
TRUSTEE	1.0	X
CLOSEY F DICKEY
TRUSTEE EMERITUS (NON VOTING)	1.0	X
BEVERLY A RANKIN
PART YEAR VP & CNO	60.0	X	X		2040	8087
JAMES R CALLAN
PART YEAR TRUSTEE	1.0	X
J TODD MILLER
COO	60.0		X		15540	133757
EVALIE M CROSBY
VP FINANCE AND CFO	60.0		X	150189	27970
DOUGLAS CEDENO MD
PHYSICIAN	40.0				23854	250969	X
CHRISTOPHER MAZUR MD
PHYSICIAN	40.0				35465	241303	X
DAVID KRONER MD
PHYSICIAN	40.0				26301	285172	X
Virginia McDougall MD
Physician	40.0				11094	272786	X
Andrew Best MD
Physician	40.0				9819	243937	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1678754	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	458840	TotalReportableCompFrmRltdOrgs
Total Other Compensation	215336	TotalOtherCompensation
Number Individuals GT100 K	25	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
MT ASCUTNEY HOSP AND HEALTH CTR
289 COUNTY RD	WINDSOR	VT	05089	PROFESSIONAL SERVICE	554930
LAVALLEE BRENSINGER ARCHITECTS
155 DOW ST SUITE 400	MANCHESTER	NH	03101	ARCHITECTS	523136
UPPER VALLEY NEUROLOGY
106 HANOVER ST	LEBANON	NH	03766	PROFESSIONAL SERVICE	266765
VALLEY REGIONAL HOSPITAL
243 ELM ST	CLAREMONT	NH	03743	LAB SERVICES	191690
COMBINED SERVICES
PO BOX 1320	CONCORD	NH	03301	PLAN ADMINISTRATION	141693

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	7	NumberOfContractorsGT100K
All Other Contributions	462323	AllOtherContributions
Total Contributions	462323	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
PATIENT SERVICE REVENUE	621400	49962376	49962376
OTHER OPERATING REVENUE	621400	164664	164664
NUTRITIONAL REVENUE	900099	96298		$96,298

Field	Value	IRS element (for citing)
Total Program Service Revenue	50223338	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	77420	TotalRevenueColumn
Exclusion	$77,420	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	53827	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	13662	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	40165	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	40165	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1909789	Securities
Other	17351	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	1775758	Securities
Other	122687	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	134031	Securities
Other	-105336	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	28695	TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Field	Value	IRS element (for citing)
Total Other Revenue	0	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	50831941	TotalRevenueColumn
Related Or Exempt Function Income	50127040	RelatedOrExemptFunctionIncome
Exclusion	$173,718	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	41450	Total
Program Services	41450	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	610657	Total
Program Services	73289	ProgramServices
Management And General	537368	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	22431256	Total
Program Services	21641484	ProgramServices
Management And General	611629	ManagementAndGeneral
Fundraising	178143	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	679040	Total
Program Services	640175	ProgramServices
Management And General	33601	ManagementAndGeneral
Fundraising	5264	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	3459014	Total
Program Services	3298555	ProgramServices
Management And General	133609	ManagementAndGeneral
Fundraising	26850	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1553757	Total
Program Services	1442041	ProgramServices
Management And General	99907	ManagementAndGeneral
Fundraising	11809	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	48872	Total
Program Services	6833	ProgramServices
Management And General	42039	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	50150	Total
Management And General	50150	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	86744	Total
Fundraising	86744	Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	5837459	Total
Program Services	5392445	ProgramServices
Management And General	417938	ManagementAndGeneral
Fundraising	27076	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	2178	Total
Program Services	360	ProgramServices
Management And General	1814	ManagementAndGeneral
Fundraising	4	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1350990	Total
Program Services	1054689	ProgramServices
Management And General	277561	ManagementAndGeneral
Fundraising	18740	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	80285	Total
Program Services	76608	ProgramServices
Management And General	2914	ManagementAndGeneral
Fundraising	763	Fundraising

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	978255	Total
Program Services	795821	ProgramServices
Management And General	174687	ManagementAndGeneral
Fundraising	7747	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	201365	Total
Program Services	179980	ProgramServices
Management And General	19655	ManagementAndGeneral
Fundraising	1730	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	0	Total

Interest Interest

Field	Value	IRS element (for citing)
Total	325233	Total
Program Services	252446	ProgramServices
Management And General	70023	ManagementAndGeneral
Fundraising	2764	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1401317	Total
Program Services	1097091	ProgramServices
Management And General	304226	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	452859	Total
Program Services	442956	ProgramServices
Management And General	9527	ManagementAndGeneral
Fundraising	376	Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
BAD DEBT EXPENSE	2596394	2596394
MEDICAID ENHANCEMENT TAX	1780816	1780816
EQUIPMENT RENTAL/MAINTENANCE	498631	484592	13995	44
MEDICAL SUPPLIES/EQUIPMENT	4298449	4296546	1678	225
ADMIN EXPENSE PAID TO AHS	483311		483311

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	70146	Total
Program Services	58261	ProgramServices
Management And General	10111	ManagementAndGeneral
Fundraising	1774	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	49318628	Total
Program Services	45652832	ProgramServices
Management And General	3295743	ManagementAndGeneral
Fundraising	370053	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1955	BOY
EOY	296478	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	4464824	BOY
EOY	6445524	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	8764	BOY
EOY	73430	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	6151124	BOY
EOY	7551295	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1158009	BOY
EOY	1220966	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	194503	BOY
EOY	372898	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	34488976	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	22113583	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	11400298	BOY
EOY	12375393	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	2555238	BOY
EOY	2827079	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	8500	BOY
EOY	8500	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	150291	BOY
EOY	128010	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	2298999	BOY
EOY	2348299	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	28392505	BOY
EOY	33647872	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	6020355	BOY
EOY	6379747	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	9021000	BOY
EOY	12144107	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
EOY	495000	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	236800	BOY
EOY	606026	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	15278155	BOY
EOY	19624880	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	11576659	BOY
EOY	13051788	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1509626	BOY
EOY	945364	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	28065	BOY
EOY	25840	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	13114350	BOY
EOY	14022992	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	28392505	BOY
EOY	33647872	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	1513313	ReconcilationRevenueExpenses
Reconcilation Other Changes	-604671	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Form4720 Filed	false	Form4720Filed
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$9,712	OtherActivitiesAmount
Total Lobbying Expenditures IIB	9712	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3
Form4720 Filed4912 Tax	false	Form4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	PART II-B, LINE 1 (I), OTHER LOBBYING ACTIVITIES:	Identifier
Return Reference	SCHEDULE C	ReturnReference
Explanation	THE ORGANIZATION PAYS DUES TO THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	28065	BeginningOfYearBalance
Investment Earnings Or Losses	-2225	InvestmentEarningsOrLosses
End Of Year Balance	25840	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	26827	BeginningOfYearBalance
Investment Earnings Or Losses	1238	InvestmentEarningsOrLosses
End Of Year Balance	28065	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	26456	BeginningOfYearBalance
Investment Earnings Or Losses	371	InvestmentEarningsOrLosses
End Of Year Balance	26827	EndOfYearBalance

Field	Value	IRS element (for citing)
Permanent Endowment EOY Balance	1.00000	PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	927577	OtherCostOrOtherBasis
Book Value	927577	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	13343955	OtherCostOrOtherBasis
Depreciation	7387375	Depreciation
Book Value	5956580	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	191748	OtherCostOrOtherBasis
Depreciation	175823	Depreciation
Book Value	15925	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	17219287	OtherCostOrOtherBasis
Depreciation	13740896	Depreciation
Book Value	3478391	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	2806409	OtherCostOrOtherBasis
Depreciation	809489	Depreciation
Book Value	1996920	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	12375393	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	DUE FROM AFFILIATES	Description
Book Value	2348299	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	2348299	TotalBookValueOtherAssets
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
DEFERRED ANNUITY	$61,218
ESTIMATED 3RD PARTY SETTLEMENTS	$328,319
INTEREST RATE SWAP	$216,489

Field	Value	IRS element (for citing)
Total Of Amounts	606026	TotalOfAmounts
Total Revenue	50831941	TotalRevenue
Total Expenses	49318628	TotalExpenses
Excess Or Deficit For Year	1513313	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-234459	NetUnrealizedGLOnInvestments
Other	-$370,212	OtherAmount
Total Adjustments	-604671	TotalAdjustments
Excess Or Deficit Per FS	908642	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	50598246	TotRevenueEtcAuditedFinclStmt
Other Revenues	13662	OtherRevenues
Revenue Not Rptd F990	13662	RevenueNotRptdF990
Revenue Subtotal	50584584	RevenueSubtotal
Other Revenues Not Included	247357	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	247357	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	50831941	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	49332290	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	13662	OtherExpensesIncluded
Expenses Not Rptd F990	13662	ExpensesNotRptdF990
Expenses Subtotal	49318628	ExpensesSubtotal
Total Expenses Per Form990	49318628	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifier	ExplanationExplanation
FORM 990, SCHEDULE D, PART X:	THE SYSTEM CONSISTS OF NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, ALL OF WHICH ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM ADOPTED FASB INTERPRETATION NO. 48 (FIN 48), ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109, EFFECTIVE OCTOBER 1, 2007. THE SYSTEM HAS EVALUATED ITS TAX POSITIONS TAKEN IN ACCORDANCE WITH FIN 48 AND HAS DETERMINED THAT THERE IS NO IMPACT ON THE SYSTEM'S CURRENT TAX-EXEMPT STATUS, OR FINANCIAL POSITION OR RESULTS OF OPERATIONS FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010. WITH FEW EXCEPTIONS, THE SYSTEM IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS PRIOR TO 2008.
FORM 990, SCHEDULE D, PART XI, LINE 8:	CHANGE IN INTEREST RATE SWAP: $216,489 LOSS ON EXTINGUISHMENT OF DEBT: $148,273 CHANGE IN ANNUITY LIABILITY: $ 5,450
FORM 990, SCHEDULE D, PART XII, LINE 2D:	RENTAL EXPENSES: $13,662
FORM 990, SCHEDULE D, PART XII, LINE 4B:	TEMPORARILY RESTRICTED CONTRIBUTIONS: $241,908 CHANGE IN ANNUITY LIABILITY: $ 5,449
FORM 990, SCHEDULE D, PART XIII, LINE 2D:	RENTAL EXPENSES: $13,662

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Mail Solicitations	X	MailSolicitations
Email Solicitations	X	EmailSolicitations
In Person Solicitations	X	InPersonSolicitations
Solicitation Of Non Govt Grants	X	SolicitationOfNonGovtGrants
Solicitation Of Govt Grants	X	SolicitationOfGovtGrants
Agreement Ref Fundraising	true	AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (2 entries)

Name Of IndividualNameOfIndividual	Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	ActivityActivity	Fundraiser Control Of FundsFundraiserControlOfFunds	Amount Retained By ContractorAmountRetainedByContractor
GRAHAM-PELTON CONSULTING INC	39 BEECHWOOD RD	SUMMIT	NJ	07901	CONSULTING	false	44000
J DONOVAN ASSOCIATES	400 CUMMING CENTER SUITE 333-D	BEVERLY	MA	01945	CONSULTING	false	42744

Field	Value	IRS element (for citing)
Total Retained By Contractors	86744	TotalRetainedByContractors
Licensed States	NH	LicensedStates

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	212.	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	629484	TotalCommunityBenefitExpense
Net Community Benefit Expense	629484	NetCommunityBenefitExpense
Percent Of Total Expense	0.01350	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	6028361	TotalCommunityBenefitExpense
Direct Offsetting Revenue	4034124	DirectOffsettingRevenue
Net Community Benefit Expense	1994237	NetCommunityBenefitExpense
Percent Of Total Expense	0.04270	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	6657845	TotalCommunityBenefitExpense
Direct Offsetting Revenue	4034124	DirectOffsettingRevenue
Net Community Benefit Expense	2623721	NetCommunityBenefitExpense
Percent Of Total Expense	0.05620	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	142681	TotalCommunityBenefitExpense
Net Community Benefit Expense	142681	NetCommunityBenefitExpense
Percent Of Total Expense	0.00310	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	94827	TotalCommunityBenefitExpense
Net Community Benefit Expense	94827	NetCommunityBenefitExpense
Percent Of Total Expense	0.00200	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	8973501	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5676080	DirectOffsettingRevenue
Net Community Benefit Expense	3297421	NetCommunityBenefitExpense
Percent Of Total Expense	0.07060	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	79917	TotalCommunityBenefitExpense
Net Community Benefit Expense	79917	NetCommunityBenefitExpense
Percent Of Total Expense	0.00170	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	9290926	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5676080	DirectOffsettingRevenue
Net Community Benefit Expense	3614846	NetCommunityBenefitExpense
Percent Of Total Expense	0.07740	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	15948771	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9710204	DirectOffsettingRevenue
Net Community Benefit Expense	6238567	NetCommunityBenefitExpense
Percent Of Total Expense	0.13360	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	6778	TotalCommunityBuildingExpense
Net Community Building Expense	6778	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	8475	TotalCommunityBuildingExpense
Net Community Building Expense	8475	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	1667	TotalCommunityBuildingExpense
Net Community Building Expense	1667	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	13029	TotalCommunityBuildingExpense
Net Community Building Expense	13029	NetCommunityBuildingExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	29949	TotalCommunityBuildingExpense
Net Community Building Expense	29949	NetCommunityBuildingExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$1,735,949	BadDebtExpenseAmount
Amount Attributable To	100000	AmountAttributableTo
Amount Reimbursed By Medicare	14850102	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	14703883	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	146219	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ALICE PECK DAY MEMORIAL HOSPITAL	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	125 MASCOMA ST	AddressLine1
City	LEBANON	City
State	NH	State
ZIP Code	03766	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours
Other	PHYSICIAN CLINICS	Other

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ALICE PECK DAY MEMORIAL HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	212.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Other Factors	X	OtherFactors
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	true	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Collection Activities	true	CollectionActivities
Report To Credit Agency	X	ReportToCreditAgency
Lawsuit	X	Lawsuit
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	9	NumberOfOtherFacilities

Other Facilities OtherFacilities (9 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
RAM CENTER FOR COMMUNITY CARE
125 MASCOMA ST 5	LEBANON	NH	03766	PRIMARY CARE PHYSICIAN CLINIC
WOMEN'S CARE CENTER
141 MASCOMA ST	LEBANON	NH	03766	OB/GYN PHYSICIAN CLINIC
APD ORTHOPAEDIC CLINIC
125 MASCOMA ST 17-C	LEBANON	NH	03766	ORTHOPAEDIC PHYSICIAN CLINIC
GENERAL SURGERY CLINIC
125 MASCOMA ST	LEBANON	NH	03766	GENERAL SURGEON CLINIC
PAIN MANAGEMENT CLINIC
127 MASCOMA ST 3RD FLOOR	LEBANON	NH	03766	PAIN MANAGEMENT CLINIC
MIDWIFERY SERVICES
57 MECHANIC ST SUITE 2	LEBANON	NH	03766	MIDWIFERY CLINIC
APD HAND & UPPER EXTREMITY CLINIC
205 BILLINGS FARM RD UNIT 3A	WHITE RIVER JUNCTION	VT	05001	HAND & UPPER EXTREMITY ORTHOPAEDIC PHYSICIAN CLINIC
OCCUPATIONAL HEALTH SERVICES
127 MASCOMA ST	LEBANON	NH	03766	OCCUPATIONAL HEALTH PHYSICIAN CLINIC
NEUROSURGERY SERVICES AT APD (NSAPD)
106 HANOVER STREET	LEBANON	NH	03766	NEUROSURGERY PHYSICIAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifier	ExplanationExplanation
SCHEDULE H, PART I, LINE 7:	THE COSTS OF CHARITY CARE, MEANS-TESTED PROGRAMS AND SUBSIDIZED HEALTH SERVICES ARE CALCULATED USING THE COST TO CHARGE RATIOS CALCULATED USING A STEP-DOWN COST ALLOCATION METHODOLOGY CONSISTENT WITH MEDICARE COST REPORT METHODOLOGY. THE COST OF FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AT COST ARE 13.36% OF TOTAL EXPENDITURES ON FORM 990, PART IX, COLUMN A, LINE 26, EXCLUDING BAD DEBT EXPENSE.
SCHEDULE H, PART I, LINE 7, COLUMN (F):	BAD DEBT EXPENSE REPORTED ON FORM 990 PART IX, LINE 25 WAS EXCLUDED FROM TOTAL EXPENSES FOR THE CALCULATION OF NET COMMUNITY BENEFIT EXPENSES AS A PERCENT OF TOTAL EXPENSE.
SCHEDULE H, PART II	ALICE PECK DAY MEMORIAL HOSPITAL PARTICIPATES IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO PROMOTE AND ADVOCATE FOR THE HEALTH NEEDS OF THE COMMUNITY. SIGNIFICANT ACTIVITIES INCLUDE PARTICIPATION IN THE UPPER VALLEY INTERFAITH PROJECT WHICH PROMOTES ADEQUATE PUBLIC TRANSPORTATION IN THE REGION, INCLUDING AVAILABILITY OF TRANSPORTATION FOR HOSPITAL AND CLINIC VISITS FOR AREA RESIDENTS. APD'S SOCIAL SERVICES DEPARTMENT WORKS WITH PATIENTS WHO SEEK ASSISTANCE WITH LIVING WILLS AND ADVANCE MEDICAL DIRECTIVES. APD PERSONNEL ARE ACTIVELY INVOLVED IN DISASTER AND EMERGENCY PREPAREDNESS PLANNING AND TRAINING ACTIVITIES. THESE ACTIVITIES ARE DESIGNED TO PROMOTE THE HEALTH AND SAFETY OF THE COMMUNITY IN THE EVENT OF WIDESPREAD OR LARGE NATURAL OR OTHER DISASTER, OR IN THE EVENT OF WIDESPREAD VIRAL OUTBREAKS, SUCH AS INFLUENZA. FINALLY, APD PERSONNEL ARE ACTIVE PARTICIPANTS IN THE NEW HAMPSHIRE HOSPITAL ASSOCIATION (NHHA). NHHA ADVOCATES FOR THE CARE AND PROTECTION OF NH HOSPITAL PATIENTS, INCLUDING MAKING QUALITY HEALTH CARE AVAILABLE, AFFORDABLE AND ACCESSIBLE TO ALL REGARDLESS OF ABILITY TO PAY.
SCHEDULE H PART III, LINE 4:	BAD DEBT COST IS CALCULATED USING A COST TO CHARGE RATIO USING A STEP-DOWN COST ALLOCATION METHODOLOGY CONSISTENT WITH MEDICARE COST REPORTING. IN FY 11, ACCOUNTS WRITTEN OFF TO BAD DEBT INCLUDED GROSS CHARGES BEING WRITTEN OFF LESS ANY PAYMENTS RECEIVED AGAINST THOSE CHARGES. ANY CASH COLLECTED ON ACCOUNTS PREVIOUSLY WRITTEN OFF IS INCLUDED AS AN OFFSET TO BAD DEBT EXPENSE AS RECOVERIES OF BAD DEBT. BASED ON LACK OF COMPLETED DOCUMENTATION, WE ESTIMATED THE AMOUNT OF CHARITY CARE IN BAD DEBT EXPENSE BASED ON THE NUMBER OF APPLICATIONS FOR CHARITY CARE. WE BELIEVE THE AMOUNT IS MINIMAL BASED ON OUR EXTENSIVE EFFORTS TO EDUCATE OUR PATIENTS AND STAFF ABOUT OUR VARIOUS PAYMENT PLANS AND CHARITY CARE TO ENSURE THAT PATIENTS WHO QUALIFY FOR ANY OF OUR PROGRAMS UTILIZE THEM. DEPENDING ON THE SPECIFIC CIRCUMSTANCES, A PATIENT MAY BE ELIGIBLE FOR CHARITY CARE, DISCOUNTED CARE, PAYMENT PROGRAMS OR A COMBINATION OF THE ABOVE. DUE TO THESE EFFORTS, WE FEEL THAT AMOUNTS WRITTEN OFF TO BAD DEBT THAT COULD QUALIFY AS CHARITY CARE ARE MINIMAL. FOOTNOTE 1 TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF ALICE PECK DAY HEALTH SYSTEMS CORP. INCLUDES THE FOLLOWING TO ADDRESS BAD DEBT: ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT ON OUTSTANDING BALANCES. MANAGEMENT PROVIDES FOR POSSIBLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF THROUGH A CHARGE AGAINST THE ESTABLISHED ALLOWANCE.
SCHEDULE H, PART III, LINE 8:	MEDICARE ALLOWABLE COSTS FOR THE MEDICARE COST REPORT ARE REPORTED IN ACCORDANCE WITH CMS GUIDELINES USING THE COST TO CHARGE RATIO METHODOLOGY.
SCHEDULE H, PART III, LINE 9B:	OUR BAD DEBTS COLLECTION POLICY APPLIES TO ALL PATIENT ACCOUNTS IN A CONSISTENT MANNER. THE POLICY SPECIFICALLY INDICATES THAT, AFTER A SECOND STATEMENT IS SENT WITH NO PAYMENT RECEIVED, A PATIENT ACCOUNTS REPRESENTATIVE WILL CONTACT THE PATIENT BY PHONE TO DETERMINE IF A FINANCIAL ASSISTANCE APPLICATION OR PAYMENT PLAN IS APPROPRIATE. THIS IS COMPLETED TO AVOID FURTHER ESCALATION OF PAST DUE ACCOUNT(S)IF THE PATIENT MAY QUALIFY FOR FULL OR PARTIAL RELIEF UNDER THE CHARITY CARE POLICY. IF THE APPLICATION IS SUCCESSFUL, THEN THE QUALIFYING BALANCE OR BALANCES ARE CLASSIFIED AS CHARITY CARE AND NO LONGER PURSUED FOR COLLECTIONS. ONCE A PATIENT BALANCE IS CLASSIFIED AS CHARITY CARE, IT IS NOT SUBJECT TO COLLECTION ACTIVITIES. ALICE PECK DAY IS COMMITTED TO HELPING OUR PATIENTS ATTAIN QUALITY HEALTHCARE, REGARDLESS OF ABILITY TO PAY. OUR FINANCIAL ASSISTANCE PROGRAMS PROVIDE, ENCOURAGE AND ENABLE OUR PATIENTS TO MAKE HEALTHCARE DECISIONS FREE OF FINANCIAL BARRIERS. WE EDUCATE OUR PATIENTS ABOUT OUR PROGRAMS AND PROVIDE ASSISTANCE PRIOR TO RECEIVING SERVICES, AT REGISTRATION FOR SERVICES AND DURING OUR BILLING PROCESS TO ENSURE THAT ANY AND ALL PATIENTS IN NEED OF ASSISTANCE ARE PROVIDED WITH THE HELP THEY NEED. BROCHURES AND SIGNS ARE PLACED IN HIGH TRAFFIC AREAS SUCH AS THE ER AND REGISTRATION. OUR STAFF IS TRAINED TO IDENTIFY PATIENTS DURING REGISTRATION, PROVIDE INFORMATION AND OFFER HELP IN COMPLETING THE NECESSARY FORMS. DURING OUR BILLING PROCESS, CALLS ARE MADE TO PATIENTS WITH OUTSTANDING BALANCES. OUR STAFF WORKS WITH PATIENTS TO IDENTIFY PROBLEMS THEY ARE FACING IN DEALING WITH OUTSTANDING BALANCES. PATIENTS ARE NOTIFIED AGAIN OF THE MANY TYPES OF FINANCIAL ASSISTANCE AVAILABLE FOR WHICH THEY MAY QUALIFY. PROGRAMS ARE EXPLAINED, AND ASSISTANCE IS OFFERED IF NEEDED, IN COMPLETING THE APPLICATIONS. DUE TO THIS MULTI-LEVEL APPROACH AND STAFF THAT IS TRAINED TO IDENTIFY CLIENTS THAT MAY NEED FINANCIAL ASSISTANCE, VERY FEW QUALIFYING PATIENTS REACH THE POINT OF BAD DEBT. OUR COLLECTION POLICIES AND PROCEDURES IN CONJUCTION WITH OUR SMALL SIZE, ALLOW OUR ORGANIZATION TO PLACE GREAT EMPHASIS ON HELPING ALL PATIENTS WHO MAY BE IN NEED TO APPLY FOR, AND ATTAIN, THE APPROPRIATE LEVEL OF FINANCIAL ASSISTANCE.
SCHEDULE H, PART V, LINE 11:	ALICE PECK DAY MEMORIAL HOSPITAL OFFERS FINANCIAL ASSISTANCE TO PATIENTS DEMONSTRATING NEED. IN MAKING THE NEED DETERMINATION, APD PARTICIPATES WITH AND HONORS THE FOUNDING PRINCIPLES AND GUIDELINES OF THE NEW HAMPSHIRE HEALTH ACCESS NETWORK (NHHAN). ACCORDINGLY, DECISIONS REGARDING THE GRANTING OF FINANCIAL ASSISTANCE WILL BE BASED PRIMARILY ON A PATIENT AND HIS OR HER HOUSEHOLD'S INCOME AND ASSETS. THERE WILL BE MINIMAL CONSIDERATION OF EXPENSES EXCEPT WHEN THEY IDENTIFY AREAS FOR FURTHER INVESTIGATION OR INCOMPLETE OR INACCURATE INFORMATION. THE VALUE OF A PATIENT'S PRINCIPAL RESIDENCE IS NOT CONSIDERED IN QUALIFYING A PATIENT FOR IN-HOUSE ASSISTANCE. APD REQUIRES EXHAUSTION OF OTHER PAYMENT METHODOLOGIES, INCLUDING BUT NOT LIMITED TO: WORKER'S COMPENSATION, VETERANS BENEFITS, MEDICAID, LIABILITY (AUTO ACCIDENTS), VICTIMS OF CRIME AND COBRA. WHEN APPLICABLE, PROOF OF DETERMINATION MAY BE REQUIRED PRIOR TO CONSIDERATION FOR FINANCIAL ASSISTANCE.
SCHEDULE H, PART V, LINE 13:	PLEASE SEE PART V LINE 3 FOR A DESCRIPTION OF THE FINANCIAL ASSISTANCE PROGRAM AND THE EFFORTS MADE TO PUBLICIZE AND PROMOTE THE PROGRAM.
SCHEDULE H, PART V, LINE 19D:	THE HOSPITAL FACILITY PROVIDES UNINSURED PATIENTS WITH A 15% DISCOUNT. AT THE TIME THE DISCOUNT WAS ESTABLISHED THE DISCOUNT APPROXIMATED THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR SERVICES AT THE HOSPITAL FACILTY. THE AVERAGE OF THE THREE LOWEST COMMERICAL INSURANCE RATES WAS APPROXIMATELY 87.5%, THE RATE APPLIED TO UNINSURED PATIENTS WAS LOWER THAN THAT RATE, AT 85%, REPRESENTING A 15% DISCOUNT.
SCHEDULE H, PART VI, LINE 2:	DUE TO OUR RURAL LOCATION AND SIZE, A COLLABORATIVE EFFORT BETWEEN THE UNITED WAY, DARTMOUTH HITCHCOCK MEMORIAL HOSPITAL AND ALICE PECK DAY MEMORIAL HOSPITAL CREATED THE FY 2009 COMMUNITY BENEFITS PLAN. PRIORITY NEEDS AND HEALTH CONCERNS FOR OUR COMMUNITY WERE BASED UPON INFORMATION COLLECTED FROM COMMUNITY NEEDS ASSESSMENTS AND COMMUNITY SURVEYS. IDENTIFIED NEEDS INCLUDED: AVAILABILITY OF ORAL HEALTH, AVAILABILITY OF PRIMARY CARE, PRESCRIPTION ASSISTANCE, TRANSPORTATION, AVAILABILITY OF BEHAVIORAL HEALTH AND ACCESS TO ALCOHOL/DRUG TREATMENT. ALICE PECK DAY USED ITS INFORMATION TO HELP FOCUS ITS COMMUNITY BENEFIT EFFORTS TO MEET THE PRIORITY NEEDS IDENTIFIED IN THE COMMUNITY BENEFIT PLAN. OF SPECIAL NOTE IS THE UPPER VALLEY SMILES PROGRAM THAT HAS SERVED A PRIORITY NEED FOR ORAL HEALTH WITHIN OUR LOCAL COMMUNITY. UPPER VALLEY SMILES HAS TOUCHED THE LIVES OF MANY CHILDREN IN OUR COMMUNITY AND PROVIDED MUCH NEEDED CARE FOR A VERY VULNERABLE POPULATION.
SCHEDULE H, PART VI, LINE 3:	ALICE PECK DAY BELIEVES THAT QUALITY HEALTH CARE SHOULD BE AVAILABLE TO ALL, REGARDLESS OF ABILITY TO PAY. OUR FINANCIAL ASSISTANCE PROGRAMS AND STAFF ARE DEDICATED TO HELPING PEOPLE OBTAIN THE CARE THEY NEED. WE REACH OUT TO OUR PATIENTS IN MANY DIFFERENT WAYS TO ENSURE THAT THEY ARE AWARE THAT HELP IS AVAILABLE AND TO HELP GUIDE THEM THROUGH THE PROCESS. BROCHURES AND SIGNAGE ARE POSTED IN HIGH TRAFFIC AREAS SUCH AS THE EMERGENCY ROOM, REGISTRATION AND THE LOBBY. REGISTRATION STAFF ARE TRAINED TO IDENTIFY PATIENTS WHO MAY BE IN NEED OF FINANCIAL ASSISTANCE. ONCE IDENTIFIED, THE STAFF NOTIFY THE PATIENT THAT APD HAS VARIOUS FORMS OF FINANCIAL ASSISTANCE AND EXPLAIN THAT ASSISTANCE IS AVAILABLE FOR ANYONE WHO MIGHT REQUIRE HELP OR GUIDANCE IN COMPLETING ANY NECESSARY PAPERWORK. IN ADDITION TO THE ABOVE, OUR BILLING STAFF ARE TRAINED TO HELP IDENTIFY AND OFFER ASSISTANCE TO ANY ONE WHO MIGHT REQUIRE FINANCIAL ASSISTANCE. PATIENTS WITH OUTSTANDING CLAIMS ARE CONTACTED BY OUR CREDIT COORDINATOR WHO WORKS WITH THEM TO CLEAR UP BALANCES THROUGH THE VARIETY OF PROGRAMS WE OFFER. ASSISTANCE IS ALSO PROVIDED IN APPLYING FOR FEDERAL/STATE PROGRAMS TO THOSE WHO QUALIFY. SPECIALLY TRAINED STAFF GUIDE APPLICANTS THROUGH THE PROCESS TO ENSURE FORMS ARE FILLED OUT CORRECTLY, ALL REQUIRED DOCUMENTATION IS ATTACHED AND THE APPLICANTS UNDERSTAND WHAT THEY CAN EXPECT TO HAPPEN ALONG THE WAY.
SCHEDULE H, PART VI, LINE 4:	ALICE PECK DAY MEMORIAL HOSPITAL IS PART OF THE LEBANON HEALTH CARE SERVICE AREA. THE LEBANON SERVICE AREA COMPRISES CITIES AND TOWNS IN NEW HAMPSHIRE AND VERMONT. APD'S SERVICE AREA IN NH COMPRISES 15 TOWNS IN ADDITION TO THE CITY OF LEBANON, INCLUDING CANAAN, CORNISH, CROYDON, DORCHESTER, ENFIELD, GRAFTON, GRANTHAM, HANOVER, LYME, NEWPORT, ORANGE, ORFORD, PIERMONT, PLAINFIELD AND WARREN. VERMONT TOWNS INCLUDE EAST THETFORD, FAIRLEE, HARTFORD, HARTLAND, NORTH HARTLAND, NORTH THETFORD, POST MILLS, QUECHEE, SHARON, SOUTH STRAFFORD, STRAFFORD, THETFORD, THETFORD CENTER, VERSHIRE, WEST VERSHIRE, WEST FAIRLEE, WEST HARTFORD, WHITE RIVER JUNCTION AND WOODSTOCK.
SCHEDULE H, PART VI, LINE 5:	ALICE PECK DAY ACTIVELY PROMOTES COMMUNITY-BASED LEADERSHIP DEVELOPMENT. STAFF MEMBERS PARTICIPATE IN TWO LOCAL CHAMBERS OF COMMERCE, LEADERSHIP UPPER VALLEY, FOUNDATION FOR HEALTHY COMMUNITIES, THE RURAL HEALTH COALITION AND THE ADVOCACY TASK FORCE. AS AN ACTIVE MEMBER OF THE COMMUNITY, APD WORKS TO BE PROACTIVE CONCERNING DISASTER READINESS. STAFF HAVE PARTICIPATED IN ONSITE TRAINING FOR DISASTER PREPAREDNESS AS WELL AS OFF-SITE TRAINING WITH OTHER REGIONAL HOSPITALS. COLLABORATIVE EFFORTS INCLUDE ALL HAZARD REGIONAL TRAINING, EMERGENCY RESPONSE TRAINING, AND A REGIONAL MASS CASUALTY RESPONSE PROGRAM TO HELP FACILITATE COOPERATIVE EFFORTS IF SUCH NEEDS ARISE.
SCHEDULE H, PART VI, LINE 6:	ALICE PECK DAY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN LEBANON NH. THE HOSPITAL IS SERVED BY A BOARD OF TRUSTEES CONSISTING OF LOCAL CITIZENS ACTIVE IN COMMUNITY ACTIVITIES AND ORGANIZATIONS. THE MAJORITY OF BOARD MEMBERS ARE NOT EMPLOYED BY THE HOSPITAL, AND INCLUDE LOCAL GOVERNMENT AND BUSINESS REPRESENTATIVES AS WELL AS PRACTICING INDEPENDENT PHYSICIANS. DESPITE ITS SMALL SIZE, APD IS COMMITTED TO GIVING BACK TO THE COMMUNITY TO THE GREATEST EXTENT POSSIBLE. DURING FY 2011, CASH DONATIONS WERE GIVEN TO MANY PROGRAMS TO HELP THOSE IN NEED. LOCAL FINANCIAL CONTRIBUTIONS HELPED SUPPORT FREE PRIMARY CARE CLINICS FOR THE UNINSURED, PROVIDED TRANSPORTATION FOR THE ELDERLY AND DISABLED TO RECEIVE MEDICAL CARE, AND PROVIDED LOCAL NON PROFIT ORGANIZATIONS WITH MEETING SPACE AND REFRESHMENTS. ALICE PECK DAY SUPPORTED COMMUNITY FLU CLINICS, PROVIDED EMERGENCY PRESCRIPTION DRUG VOUCHERS, SUBSIDIZED SENIOR EXERCISE PROGRAMS, PROVIDED SUPPLIES FOR HURRICANE IRENE RELIEF, AND WORKED TOWARD THE EXPANSION OF LOCAL PUBLIC TRANSPORTATION TO ENSURE ALL THOSE IN NEED OF MEDICAL CARE COULD RECEIVE IT. ONE OF APD'S MOST EXCITING AND CELEBRATED PROGRAMS IS THE UPPER VALLEY SMILES PROGRAM. THIS PROGRAM PROVIDES AN ORAL HEALTH SAFETY NET FOR DISADVANTAGED RESIDENTS WITHIN OUR SERVICE AREA. IN 6 DIFFERENT SCHOOLS OVER 783 STUDENTS RECEIVED ORAL HEALTH EDUCATION. DENTAL SCREENINGS WERE PROVIDED TO 239 OF THOSE CHILDREN, WITH 157 RECEIVING DENTAL SEALANTS AND 126 REFERRED TO DENTISTS FOR RESTORATIVE TREATMENT. NINETEEN CHILDREN REQUIRING URGENT CARE RECEIVED REFERRALS AND HAD THEIR CARE PAID FOR BY APD. ALICE PECK DAY HOSTED TWO FREE ORAL HEALTH CLINICS FOR 18 HOMELESS CHILDREN WHO RECEIVED ORAL HEALTH EDUCATION, A DENTAL CLEANING AND FLUORIDE APPLICATIONS. WITH THE HELP OF TWO GRANTS, APD CONTINUED ITS PILOT WOMEN, INFANTS AND CHILDREN (WIC) ORAL HEALTH INITIATIVE IN LEBANON AND ENFIELD, NH. A TOTAL OF 177 LOW-INCOME CHILDREN AGED 0-10 RECEIVED ORAL HEALTH EDUCATION, A DENTAL SCREENING AND PREVENTATIVE CARE. AS A RESULT OF THIS SUCCESS, AN ADDITIONAL GRANT FROM AN ADDITIONAL FUNDING SOURCE WAS SECURED, ENABLING THE HOSPITAL TO EXPAND ITS WIC ORAL HEALTH PROGRAM INTO THE HARTFORD, VERMONT AREA BEGINNING IN 2012. INDIVIDUALS WERE PROVIDED WITH ASSISTANCE IN APPLYING FOR NH/VT MEDICAID TO ENSURE INCREASED ACCESS TO MEDICAL CARE FOR THIS NEEDY POPULATION. AS A RESULT, A SIGNIFICANT NUMBER OF PEOPLE WERE SUCCESSFULLY ENROLLED AND RECEIVED ONGOING CARE. TO PROMOTE HEALTH PROFESSIONAL EDUCATION, APD PROVIDED CLINICAL UNDERGRADUATE TRAINING TO DARTMOUTH MEDICAL SCHOOL, RIVER VALLEY COMMUNITY COLLEGE, VERMONT TECHNICAL COLLEGE AND LEBANON COLLEGE. APD ANNUALLY SPONSORS DISTRICT-WIDE PROFESSIONAL DEVELOPMENT FOR SCHOOL NURSES IN OUR LOCAL AREA AND FOR OTHERS WITHIN OUR REGION. THESE INITIATIVES AND ONGOING EFFORTS CONTINUE TO ADDRESS SEVERAL OF THE MOST PRESSING COMMUNITY NEEDS AS IDENTIFIED IN OUR COMMUNITY NEEDS ASSESSMENT.
SCHEDULE H, PART VI, LINE 7:	APD FILES A COMMUNITY BENEFIT REPORT IN NEW HAMPSHIRE.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
GOOD NEIGHBOR HEALTH CLINIC
70 N MAIN ST	WRJ	VT	05001	030346949	501(c)3	20000	OPERATIONAL SUPPORT FOR CLINIC PROVIDING FREE PRIMARY CARE SERVICES TO PATIENTS IN THE UPPER VALLEY ARE OF NH AND WHITE RIVER JUNCTION AREA IN VERMONT. PATIENTS RECEIVING FREE CARE ARE AT OR BELOW 225% OF THE FEDERAL POVERTY LEVEL.
GRAFTON COUNTY SENIOR CITIZENS COUNCIL
PO BOX 433	LEBANON	NH	03766	237248316	501(c)3	20000	Operational support for transportation services for area senior-citizens. The Council provides lift-assisted buses with priority on medical transport for hospital or clinic appointments.

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	2	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Schedule I, Part 1, Line 2	Identifier
Explanation	As part of APD's Access Improvement Plan developed in 2003, Hospital staff and Board members identified the Grafton County Senior Citizens Council and the Good Neighbor Health Clinic (which also includes the Red Logan Dental Clinic) as essential to providing access to health care in the Upper Valley NH and White River VT areas. Based on the needed services provided, the Board approved on-going monetary support for these organizations. The annual amount to be contributed by APD to these organizations is approved annually through the annual budget process. APD receives and reviews each year the organizations' published annual reports and also maintains informal contacts throughout the year to monitor the organizations' operations and services.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	true	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgs	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Base Compensation Filing OrgBaseCompensationFilingOrg	Other Compensation Filing OrgOtherCompensationFilingOrg	Deferred Comp Filing OrgDeferredCompFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
HARRY G DORMAN III
263689	44962	9800	18561	337012
SUSAN E MOONEY MD
					224617	18126	9800	25092	277635
EVALIE M CROSBY
136678	13511	4810	23160	178159
DOUGLAS CEDENO MD
					223821	27148	9800	14054	274823
CHRISTOPHER MAZUR MD
					225366	15937	9100	26365	276768
DAVID KRONER MD
					263484	21688	9800	16501	311473
Virginia McDougall MD
					270593	2193		11094	283880
Andrew Best MD
					243385	552	2682	7137	253756

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifier

ExplanationExplanation

FORM 990, SCHEDULE J, PART I, LINE 7:

IN FISCAL YEAR 2011, CERTAIN PROVIDERS WERE PAID THROUGH AN RVU (RELATIVE VALUE UNIT) SYSTEM, A PRODUCTIVITY MEASUREMENT SET BY MEDICARE TO ASSIGN VALUE TO SERVICES.

FORM 990, SCHEDULE J, PART II:

SALARY AND BENEFIT EXPENSE FOR THE CEO AND CFO ARE CHARGED TO APD HEALTH SYSTEMS AND THEN ALLOCATED TO ALICE PECK DAY MEMORIAL HOSPITAL AND ALICE PECK DAY LIFECARE INC. BASED ON THE RELATIVE SHARE OF SERVICES PERFORMED FOR THOSE ENTITIES. ON THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS THESE EXPENSES ARE INCLUDED IN SALARIES AND BENEFITS EXPENSE. ON LINE 24(E) OF FORM 990, SCHEDULE IX , THESE EXPENSES ($483,311) HAVE BEEN RECLASSIFIED FROM SALARY AND BENEFIT EXPENSE TO LINE 24(E).

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	BUSINESS FINANCE AUTHORITY OF THE STATE OF NH	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	521304598	IssuerEIN
Date Issued	2010-11-30	DateIssued
Issue Price	12282000	IssuePrice
Description Of Purpose	CURRENT REFUND EXISTING BONDS	DescriptionOfPurpose
Defeased	false	Defeased
On Behalf Of Issuer	false	OnBehalfOfIssuer
Pool Financing	false	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	12282000	TotalProceeds
Refunding Escrow	12237068	RefundingEscrow
Issuance Costs From Proceeds	44932	IssuanceCostsFromProceeds
Year Of Subst Completion	2010	YearOfSubstCompletion
Current Refunding	true	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	true	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	false	OwningBondFinancedProperty
Any Lease Arrangements	false	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	false	MngmentCntrctBondFinancdPrprty
Any Research Agreements	false	AnyResearchAgreements
Bond Counsel Routinely Engaged	true	BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse
Post Issuance Compliance Procdrs	true	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	false	Form8038TFiled
Variable Rate Issue	true	VariableRateIssue
Hedge Identified In Books And Recds	true	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	TD BANK NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Term Of Hedge	5.	TermOfHedge
Superintegrated Hedge	false	SuperintegratedHedge
Hedge Terminated	false	HedgeTerminated
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC
Gross Proceeds Invested	false	GrossProceedsInvested
Exception To Rebate	true	ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART I, LINE 5 AND PART V, LINE 2A:	FOR ADMINISTRATIVE PURPOSES, ALICE PECK DAY MEMORIAL HOSPITAL ACTS AS COMMON PAYMASTER FOR BOTH ALICE PECK DAY HEALTH SYSTEMS CORP. AND ALICE PECK DAY LIFECARE CENTER, INC.
FORM 990, PART IV, LINE 34:	INACTIVE ENTITIES THE ORGANIZATION IS RELATED TO ALICE PECK DAY REALTY CORP. (EIN 02-0485369) AND ALICE PECK DAY HEALTH MANAGEMENT CORP.(EIN 02-0485370) THROUGH THE DIRECT CONTROLLING PARENT, ALICE PECK DAY HEALTH SYSTEMS CORP. BOTH ENTITIES ARE INACTIVE AND HOLD NO ASSETS.
FORM 990, PART VI, SECTION A, LINE 6:	ALICE PECK DAY HEALTH SYSTEMS CORP, A CHARITABLE CORPORATION, ACTING BY AND THROUGH ITS BOARD OF TRUSTEES, IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A:	ALL TRUSTEES SHALL BE ELECTED BY THE BOARD OF TRUSTEES OF THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER. A NOMINATION SLATE FOR THE TRUSTEES SHALL BE SUBMITTED BY THE GOVERNANCE COMMITTEE OF THE MEMBER. ANY TRUSTEE MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE, BY THE MEMBER. VACANCIES ON THE BOARD OF TRUSTEES DUE TO DEATH, RESIGNATION, OR OTHER CAUSE EXCEPT REMOVAL SHALL BE FILLED BY ELECTION BY THE REMAINING MEMBERS OF THE BOARD.VACANCIES CAUSED BY REMOVAL SHALL BE FILLED BY ELECTION BY THE MEMBER. TRUSTEES ELECTED TO FILL VACANCIES SHALL HOLD OFFICE UNTIL THE NEXT ANNUAL MEETING OF THE MEMBER, AT WHICH TIME SUCCESSORS SHALL BE ELECTED IN THE MANNER PROVIDED FOR IN THE CASE OF ORIGINAL ELECTIONS.
FORM 990, PART VI, SECTION A, LINE 7B:	THE ORGANIZATION'S ANNUAL OPERATING BUDGET AND ALL CAPITAL BUDGETS SHALL BE SUBJECT TO APPROVAL BY THE MEMBER. ANY OVERALL STRATEGIC PLAN FOR THE ORGANIZATION, INCLUDING THE DEVELOPMENT OF OFF-SITE FACILITIES, THE ADDITION OF NEW PROGRAMS AND AFFILIATIONS WITH OTHER INSTITUTIONS, SHALL BE CONSISTENT WITH THE STRATEGIC PLAN OF THE MEMBER AS DETERMINED BY THE MEMBER. THE BORROWING OF ANY SUM IN EXCESS OF $50,000 WHICH HAS A STATED TERM OF GREATER THAN ONE YEAR OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE ORGANIZATION'S REAL PROPERTY OR BY A SECURITY INTEREST IN THE ORGANIZATION'S ASSETS OR REVENUES SHALL BE SUBJECT TO APPROVAL BY THE MEMBER, PROVIDED, HOWEVER, THAT THE APPROVAL BY THE MEMBER SHALL NOT BE NECESSARY FOR ANY BORROWING TO PURCHASE OR LEASE EQUIPMENT OR OTHER PERSONAL PROPERTY SECURED BY A PURCHASE MONEY LIEN OR TITLE RETENTION OR SECURITY AGREEMENT EXCEPT AS INCIDENT TO THE REVIEW OF THE CAPITAL BUDGET. ANY VOLUNTARY DISSOLUTION, MERGER OR CONSOLIDATION OF THE ORGANIZATION OR THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS OR THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE CORPORATION SHALL BE SUBJECT TO APPROVAL BY THE MEMBER. THE BOARD SHALL SELECT AS CERTIFIED PUBLIC ACCOUNTANTS FOR THE ORGANIZATION THE FIRM WHICH AUDITS THE BOOKS AND RECORDS OF THE MEMBER. THE BOARD SHALL SELECT THE PRESIDENT WHO MUST BE CONFIRMED BY THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11:	THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF THE FINANCE AND GOVERNANCE COMMITTEES OF THE BOARD OF TRUSTEES IN ADVANCE OF THE FILING DEADLINE TO ENABLE A DETAILED AND CONSCIENTIOUS REVIEW BY ALL MEMBERS OF BOTH COMMITTEES. THE COMPLETED FORM 990 IS ALSO DISTRIBUTED TO ALL MEMBERS OF THE FULL BOARD FOR REVIEW NO LATER THAN THE FINAL REGULARLY SCHEDULED BOARD MEETING PRIOR TO THE FILING DEADLINE. ALL QUESTIONS AND CONCERNS ARE ADDRESSED BY THE CHIEF FINANCIAL OFFICER AND INCORPORATED INTO THE FORM 990 AS DEEMED APPROPRIATE. AFTER ALL INPUT FROM THE BOARD, FINANCE, AND GOVERNANCE COMMITTEES HAS BEEN APPROPRIATELY ADDRESSED AND INCORPORATED INTO THE FINAL FORM 990, A VOTE OF ACCEPTANCE OF THE FINAL DOCUMENT IS REQUIRED. THE VOTE IS RECORDED IN THE MINUTES OF THE BOARD OF TRUSTEES PRIOR TO THE FILING OF THE FORM 990. ONCE APPROVED, SENIOR MANAGEMENT FILES THE FINAL FORM 990 WITH THE INTERNAL REVENUE SERVICE AS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 12C:	ALICE PECK DAY HAS A MULTI-FACETED CONFLICT OF INTEREST POLICY. THE BOARD OF TRUSTEES COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS AND ANY NEW MEMBERS COMPLETE THE QUESTIONNAIRE UPON JOINING THE BOARD. AS PART OF OUR ONGOING MONITORING PROCESS, OUR EXECUTIVE ASSISTANT REVIEWS ALL BOARD QUESTIONNAIRES AND DISCLOSURES TO IDENTIFY ANY POTENTIAL CONFLICTS BEFORE THEY ARISE. IN ADDITION, OUR EXECUTIVE ASSISTANT ATTENDS ALL BOARD MEETINGS TO ENSURE THAT IF ANY CONFLICTS ARISE, THEY ARE HANDLED APPROPRIATELY. IF SUCH CONFLICTS ARISE, THE ORGANIZATION COMPLIES WITH THE NEW HAMPSHIRE AND FEDERAL REQUIREMENTS FOR DISCLOSURES OF SUCH EVENTS. THE ORGANIZATION IS COMMITTED TO CONDUCTING ITS BUSINESS IN A MANNER THAT IS BOTH ETHICAL AND LEGAL. AS PART OF THIS COMMITTMENT, A STANDARD OF CONDUCT FORM IS REQUIRED OF ALL EMPLOYEES OF THE ORGANIZATION. THIS IS REVIEWED WITH ALL STAFF UPON HIRE AND ON AN ANNUAL BASIS THEREAFTER. THE STANDARD OF CONDUCT COVERS CONFLICT OF INTEREST AND OTHER VITAL MATTERS TO ENSURE ALL BUSINESS ACTIVITY IS CONDUCTED IN A MANNER THAT IS CONSISTENT WITH THE HIGHEST STANDARDS OF HONESTY, INTEGRITY AND FAIRNESS.
FORM 990, PART VI, SECTION B, LINE 15:	THE COMPENSATION COMMITTEE OF THE ALICE PECK DAY HEALTH SYSTEMS BOARD OF TRUSTESS IS RESPONSIBLE FOR DETERMINING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER/PRESIDENT. THE HUMAN RESOURCE DIRECTOR PROVIDES COMPENSATION DATA OF COMPARABLE ORGANIZATIONS WITH APPROXIMATELY THE SAME SIZE STAFF AND SPENDING IN A LOCATION OF SIMILIAR SIZE. THE COMMITTEE DETERMINES THE APPROPRIATE COMPENSATION AND APPROVES THE AMOUNT THAT IS THEN COMMUNICATED TO HUMAN RESOURCES FOR ADJUSTMENT. THE CEO/PRESIDENT IS RESPONSIBLE FOR REVIEWING THE PERFORMANCE OF SENIOR MANAGEMENT STAFF. THE INFORMATION IS BROUGHT TO THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES ALONG WITH A RECOMMENDATION FOR THE SALARY OF EACH INDIVIDUAL. THE COMPENSATION IS DETERMINED THROUGH A VARIETY OF ANALYSIS OF SALARY DATA AND PERFORMANCE. INDIVIDUAL SALARY INCREASES ARE THEN BASED ON OVERALL PERFORMANCE, WITHIN BUDGETED INCREASES FOR THE ORGANIZATION. THE COMPENSATION COMMITEE APPROVES THE BASE COMPENSATION AND SALARY INCREASE AMOUNT.
FORM 990, PART VI, SECTION C, LINE 19:	THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, SECTION A, COLUMN E:	DR. SUSAN E. MOONEY IS A PRACTICING PHYSICIAN IN ADDITION TO BEING THE HOSPITAL'S CHIEF MEDICAL OFFICER. SHE WORKED AN AVERAGE OF 60 HOURS PER WEEK, OF WHICH AN AVERAGE OF 40 HOURS PER WEEK WERE SPENT ON EXECUTIVE MATTERS AND 20 IN HER ROLE AS A PHYSICIAN.
FORM 990, PART XI, LINE 2C:	OVERSIGHT OF AUDIT PROCESS THE AUDIT COMMITTEE OVERSEES THE AUDIT PROCESS FOR THE ALICE PECK DAY ENTITIES. THE AUDIT PROCESS FOR THE FINANCIAL STATEMENTS DID NOT CHANGE FROM THE PRIOR YEAR. INDEPENDENT ACCOUNTANTS PERFORMED THE AUDIT FOR THE FISCAL YEARS ENDED 9/30/10 AND 9/30/11.
FORM 990, PART XI, LINE 5:	OTHER CHANGES IN NET ASSETS OR FUND BALANCE: CHANGE IN INTEREST RATE SWAPS: -216,490 LOSS ON EARLY EXTINGUISHMENT OF DEBT: -148,273 UNREALIZED LOSS ON INVESTMENTS: -234,459 CHANGE IN ANNUITY VALUATION: -5,449
HOURS DEVOTED FOR RELATED ORGANIZATION	NAME:PAUL R. BOUCHER TITLE:CHAIR- APD LIFECARE HOURS:1	FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Business Name Line1DirectControllingEntityName/BusinessNameLine1
ALICE PECK DAY HEALTH SYSTEMS CORP
125 MASCOMA ST	LEBANON	NH	03766	020479095	PROMOTE HEALT	NH	501(C)(3)	LINE 11B,II	N/A
ALICE PECK DAY LIFECARE CENTER INC
125 MASCOMA ST	LEBANON	NH	03766	020479094	ASSISTED LIVI	NH	501(C)(3)	LINE 9		APDHS
ALICE PECK DAY REALTY CORP
125 MASCOMA STREET	LEBANON	NH	037662647	020485369	INACTIVE	NH	501(c)(2)			APDHS

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	ALICE PECK DAY HEALTH MANAGEMENT CORP	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	125 MASCOMA ST	AddressLine1
City	LEBANON	City
State	NH	State
ZIP Code	037662647	ZIPCode

Field	Value	IRS element (for citing)
EIN	020485370	EIN
Primary Activity	INACTIVE	PrimaryActivity
Legal Domicile State	NH	LegalDomicileState
Type Of Entity	C corp.	TypeOfEntity
Percentage Ownership	1.00000	PercentageOwnership

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	true	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	true	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
ALICE PECK DAY HEALTH SYSTEMS CORP
D	1117757
ALICE PECK DAY LIFECARE CENTER INC
P	3648954
ALICE PECK DAY LIFECARE CENTER INC
D	1230536